You’ve probably seen the advertisements for Harvoni, the new medication for Hepatitis C. Hepatitis C has become more and more common with the rising incidence of IV drug use. About 2.7-3.9 million people in the US have chronic Hepatitis C. That means that if you don’t have Hepatitis C yourself, you probably know someone who does.
In order to understand how Harvoni works, it helps to understand some things about Hepatitis C. Most people don’t really know the difference between Hepatitis A, B, and C. They are caused by 3 different viruses. Infection from the Hepatitis A virus usually comes from contaminated food or water. It can be passed through feces. It’s usually an acute infection that does not become chronic. Hepatitis B virus infection usually occurs when blood or body fluids, such as semen from an infected person, enter the body of an uninfected person. This can occur when IV drug users share needles with other users. Hepatitis B can also be transmitted during birth to the newborn from an infected mother or through sexual contact. Hepatitis B can become chronic though it doesn’t always happen. There are vaccines to prevent hepatitis A and B, but not Hepatitis C.
Hepatitis C is acquired through blood to blood transmission. It can be sexually transmitted if there is some blood/blood exchange, but that isn’t common. The most common cause of Hepatitis C is IV drug use. Hepatitis C can be transmitted to a newborn during birth. Rarely transmission could occur if a non-infected person uses a razor that has blood from an infected person, or if somehow blood from an infected person enters an open wound of a non-infected person, for example needle-sticks in the health care setting. It can be acquired through tattoos is the tattoo needle was not cleaned properly and has the blood of someone with hepatitis C on it. People who received blood transfusions or organ transplants before 1992 are at risk because there was no screening for HIV and hepatitis C in blood donors before that.
Common symptoms of Hepatitis C are decreased appetite, abdominal pain, dark urine, or light, grayish stools, or jaundice.
Harvoni is unique in that the dose is only one pill per day. Several years ago, when hepatitis C was treated with interferon, ribavirin, and proteases, patients took up to 18 pills per day and the chance of cure was not that impressive. So a 95 % cure rate with a dose of only one pill per day is pretty amazing. However, there are some caveats.
First of all, patients need to be tested to determine the genotype of their Hepatitis C virus. There are 6 different “strains” of Hepatitis C virus. The most common strain in the US is Genotype 1. Harvoni is effective with genotype 1 Hepatitis C. Most patients need to take it for 12 weeks though sometimes it only takes 8 weeks. Or course, people who are generally healthy other than the Hepatitis C usually have the best response. In January, 2016, two more medications were approved that are effective for the other genotypes. They are just becoming available. So Hepatitis C can be cured.
There are some side effects. Most people taking any of these hepatitis medications feel tired. Some patients feel a little weak or lightheaded or foggy in their thinking. With the older medications, such as interferon, there was an incidence of severe depression. That is less common with the new medications.
Unfortunately, it can be difficult to get insurance companies to pay for the new drugs until the person has fairly advanced disease. That makes no sense because people are more likely to respond quickly before they are extremely ill. But that’s how insurance companies operate.
If you have risk factors, it is definitely worth being tested for Hepatitis C. Most people don’t even know that they have it early in the course of the disease. Occasionally, some people can clear the virus without treatment. However, if you do have it, you need to be monitored. It can progress to cirrhosis if not treated.